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New Perspectives on Ethics, Session 1: Comment Board

 

Thank you to everyone who attended the first session of “New Perspectives: Ethical Standards for the 21st-Century Practitioner.” We hope that this 5-part webinar series, featuring leading experts on ethical therapeutic practice, will provide you with practical and enlightening discoveries of modern ethical strategies and boundaries.

Today’s session with Mary Jo Barrett, “Ethical Dilemmas for the 21st-Century Practitioner” focuses on ambiguous situations: how to keep to our ethical boundaries while utilizing our clinical wisdom.

Using the Comment Boards provided after each session will help all of us process what we’ve learned so far and what questions we may have. It’s most helpful when all of us take a few moments to share relevant experiences, questions, or reflections. What stood out for you during today’s session? What do you think will be most applicable to you—professionally or personally?

In order to create a better sense of community, we invite you to please include your name and hometown along with your comment. Thank you all so much for your participation and thought-provoking reflections.


01.17.2011   Posted In: P002 New Perspectives: Ethical Standards for the 21st Century Practitioner   By Rich Simon
40
Comments
     

    • 0 avatar Cynthia Kelly 01.18.2011 07:18
      from Cynthia Kelly, Chester Springs, PA:

      I especially appreciated Mary Jo's emphasis on processing almost all of these ethical dilemmas (other than therapist's crushes) with the client. My Gestalt training has always steered me in that direction, and I felt very affirmed by everything she explained. I also liked her distinction of when to attend client "rituals" - only go to ceremonies, but not to parties. That was very helpful and has cleared up for me what I felt all along - I attended a non-traditional student's graduation from junior college, but did not feel comfortable going to the party afterward.
      Reply
    • 0.1 avatar Jacquie Latzer 01.18.2011 07:19
      Jacquie Latzer - Cornelius, NC
      I appreciated Mary Jo's honest examples. Especially helpful her approach to answering person questions, exploring the positives and negatives of doing so. Also a good reinforcement and good examples of collaboration with client. Thank you.
      Reply
    • 0 avatar Susan Bolotin 01.18.2011 07:23
      Susan -- Seattle
      Because some of my DID clients are artists/writers, I have had to grapple with the dilemma of clients wanting to give me gifts of their work. When I began my career as a therapist several decades ago, I maintained an absolute boundary of not accepting any gifts and, of course, explaining the ethics of why and discussing clients feelings and thoughts about themselves about this.
      Over the years, my thinking about gifts has changed. It has been therapeutic for clients to discover why it feels important to them to give me a gift. Is it a re-enactment from the past? One common response is to feel special. I've tried different approaches like creating a rock garden in my office where clients can add a rock they found to the collection.
      I continue to struggle with this dilemma, however. It would be helpful to me to hear how other clinicians handle gifts.
      Reply
      • Not available avatar 01.20.2011 17:17
        Hi susan, I am sorry that I did not spend a bit more time to discuss gifts. I will bug Rich for us to do a follow-up as you can imagine, I could talk for days about this topic, better watch my boundaries once i start talking. Gifts, a few quick ideas. I love to give and get gifts that are metaphoric. So for example, Batteries to help my clients to keep on going. Or paper clips to hold things together. I also give gifts as part of ritual for the therapy. I have given journals, or certain books. I also have given small metaphoric tokens for life cycle events. I often use the holidays as an opportunity to discuss gifts with my clients. Sometimes clients might give a gift of toys for our play therapy room. And if someone gives something expensive, I take a very honest approach and talk about it in the context of dual relationships. I love the Rock Garden idea, i think I am going to borrow it with your permission. Just a few ideas, perhaps we can begin a discussion with others. Thanks for the feed back

        Mary Jo
        Reply
    • 0 avatar Susan Goedde 01.18.2011 07:30
      Susan Goedde - Seattle, WA

      Thank you so much, Mary Jo, this was very helpful. You have given me some good suggestions for ways to discuss these issues with clients in a more substantive way, rather than assuming I know what they feel.
      Reply
    • 0 avatar Diana Sillence 01.18.2011 07:34
      Diana -- Lutz, Florida
      Your discussion on ethics has been the best I've ever "attended." You put a lot of emphasis on how much you discuss regarding expectations and safety. Because your concepts are new to me in regards to discussing with clients these various issues, I will have to start slowly so I feel comfortable in "taking their time." Clients are so ready to begin speaking about the reasons they are coming in and what they want, I will now learn to do a more introductory portion to emphasize their feeling of safety. Thanks for a REAL workshop on ethics. Very helpful and thought provoking.
      Reply
    • 0 avatar Diana Sillence 01.18.2011 07:42
      Diana -- Lutz, Florida
      In response to Susan in Seattle, I will always accept gifts from children. However, when it comes to adults, it is a very gray area. In response to how Mary Jo handles it by discussing gift-giving in the beginning, gifts may never be an issue. I always ask myself, "Is it therapeutic for the client?" Most clients I have had feel rejected if the gift is rejected, so I usually accept their token of appreciation. On the other hand, talking about gifts in the first session may eliminate these uncomfortable moments. Thanks again, Mary Jo.
      Reply
    • 0 avatar Jillian Beverstock 01.18.2011 07:57
      This was a very important seminar and I would like to thank you, Mary Jo for your honesty and help with these issues that arise all the time. I was especially interested in how to deal with several issues and how important you said that talking with your client about it will give the client power and created safety which is the most important.
      If I receive a gift, I will talk with the client about how it can be shared with others or what their meaning of giving the gift is.
      Thanks you so much again, Mary Jo.
      Jillian88, NH
      Reply
    • 0 avatar Kathleen Barry 01.18.2011 08:12
      Kathy, Berkeley CA
      I also really appreciated the openness of this seminar. Mary Jo gave me a lot of food for thought. I'm currently working with Internal Family Systems therapy and see the safety issues of "boundaries" works well w/ IFS focus on respect for "parts" - both of clients' and of therapists. It also raises a lot of questions.
      Last comment - I wish the technology were better so that the speakers wouldn't speak over one another. Any way of addressing that?
      Reply
    • 0 avatar Lori Rampone 01.18.2011 09:52
      I agree with the majority of what has already been said. I want to thank Mary Jo for her honesty and helpful tips on how to initiate discussions about ethical dilemmas. This was the most helpful ethics course I've had to date. I have had more questions after other courses than answers. Mary Jo provided great suggestions for approaching ethical dilemmas. I agree that the technology needs improvement as sometimes the presenters talked over each other (or that's how it came across). Additionally, I would like to know why the CE quizzes won't be available until after the entire course. It's easier for me to remember course material right after the course, instead of weeks later. Thanks for a great workshop!
      Reply
      • 0 avatar Tina Denison 09.08.2011 13:25
        I, too, would find smaller quizzes more useful right after each webinar, It helps me process, digest, and retain the material that was most important to me.
        Tina LeMarque, Tucson, AZ
        Reply
    • 0 avatar carolyn koehnline 01.18.2011 15:27
      Carolyn, Bellingham, Washington
      I especially appreaciated how realistic Mary Jo is about practitioners working in smaller communities - navigating the potential of dual relationships, privacy, etc and admitting that these are such grey areas. I also especially appreciated her thorough guidance about how to make a meaningful discussion out of these dilemmas instead of what could easily feel like a wall being thrown up in front of the client. How great that instead establishing boundaries can be a collaborative act. I appreciate too that these ethical guidelines grow out of Mary Jo's direct experience of what is helpful to the client, rather than being a fear-based response to regulations.
      Reply
      • Not available avatar 01.21.2011 14:55
        Ditto, Carolyn in Bellingham
        Reply
    • 0 avatar Arthur R Williams 01.18.2011 22:41
      Art Rural Iowa/Tampa Florida

      The therapeutic path is strewn with boulders of self-deception and potholes of mutual seduction. Successful navigation depends upon the wisdom of the participants in knowing and ascertaining the difference between therapy and manipulation and the ability to inter-act accordingly. Staying within Mary Jo's sports metaphor, were I to engage my patients in so prolonged a preliminary setting of "protective" ground rules as her discussion suggests (protective of whom?), I expect many would flee the playing field in search of a cold/warm shower before the game commenced. But what do I know? I'm just an old Freudian, field-theorist fart.
      Reply
    • 0 avatar Irene Kennedy 01.19.2011 10:02
      Good format for this issue. It's always good to hear ethics discussed in this manner and no matter how long one has been in practice. Very helpful and useful. Thank you.
      Irene Kennedy, Raleigh, NC
      Reply
    • 0 avatar Ruth Gibian 01.20.2011 07:47
      I appreciate the attention to how a client experiences something rather than hard and fast rules, since that's what we are charged with -- protecting the experience of safety in therapy. I also appreciate the discussion of dual relationships in communities, since there are smaller communities even in larger cities. I've wondered about the ethics of having one of our children interact with clients in a dual relationship -- e.g., not the caterer but someone like a teacher, music teacher, etc. It feels complicated to me to, say, avoid a preschool/private school/etc that would be the best fit for a child just because a client teaches there. Surely it is fraught, but very grey. If we have worked in the area for many years, it gets increasingly grey; what if the teacher was a client several years ago?

      (p.s. -- Hi Carolyn in Bellingham!)

      Ruth, Portland, OR
      Reply
    • 0 avatar Merrilee Gibson 01.21.2011 06:20
      I appreciated the information and style of this presentation. I have a question. Mary Jo answered several times that these ethical areas/questions are addressed in the first session. So my question is, how much time is spent in first session on ethical considerations? I find that new clients are wanting to get to discussion and consideration of their issues, particularly if there is something currently distressing to them. How do you balance ethical coverage with addressing presenting issues of the client? Thank you for your help.
      Merrilee, San Mateo, CA
      Reply
    • Not available avatar 01.21.2011 14:53
      The content was timely, appropriate and very helpful. I did have some issues with the format. I would have preferred a straight presentation to go along with the power point slides rather than the dialogue between Rich and Mary Jo.
      Reply
    • 0 avatar Andrew Bernstein 01.21.2011 14:56
      A lot of the work I do as a white therapist with inner-city HIV+ clients is with folks who often feel somewhat victimized by "the system" of health care, law enforcement, economics, etc. One of the ways that I think I've been successful with this population is by bringing up race in the beginning of our work together. After this presentation, I realize that I'm giving them permission to look at a boundary, and declaring it safe to address the relationship between us as collaborators, something that they very often are denied the opportunity to do in other health care settings. Thanks for a good conversation; next time I hope to be able to watch it live.

      Andy Bernstein in northern New Jersey
      Reply
    • 0 avatar Richard Karelis 01.21.2011 17:46
      Thank you for the informative discussion. I found the personal anecdotes especially helpful. Your approach to self-disclosure raised some questions for me. What do you do about responding to a client's question if they still insist on receiving an answer even after the pros and cons of sharing such information have been explored? Your experience indicated it was never an issue, but I believe there are clients who feel compelled to know certain information about their therapist even after such discussion. How would you respond if it seems inappropriate or truly not in the client's best interest?

      Richard in NY
      Reply
    • Not available avatar 01.22.2011 01:25
      First, I would like to thank Rich Simon and the Networker for the free rebroadcasts of the sessions in this and other webinars! I think it will be fascinating to compare and contrast Mary Jo's perspectives with the others yet to come, ecpecially Ofer Zur's, which is next. I have attended a webinar with him for ethics and his positions offer quite a different viewpoint on a subject that is so important for practitioners. Thanks to Mary Jo for her fulsome examples.
      Reply
    • 0 avatar Candace Sindoris 01.23.2011 05:42
      Candace - CO
      Is there a way to get a copy of the power point to help remember all of the valuable information that was shared?
      Thanks
      Reply
    • 0 avatar patricia hoeft 01.24.2011 11:04
      I agree with so many that this is one of the best seminars on ethics that I have ever heard. I love metaphors and analogys and the picture of the therapist as an athlete and needing to stay strong to be able to combat the boundaries that are sure to be broken by clients and how to handle them with care and ethical standards struck a chord with me. Although our own lives are never fully without stress - knowing how to deal with it and refresh oneself is so very important. I have shared this web site with many of my peers. Thank you all for your skills and willingness to share. Patricia - Chelsea , Mi
      Reply
    • Not available avatar 01.24.2011 14:28
      Amberly - North Carolina
      I was grateful for the discussion of dual relationships in rural areas. I live on an island, I trip over dual relationships walking out the door. I try to discuss "at the beginning" as suggested, and try especially to limiting the conversations even if they are okay with public acknowledgment because I am wary of the "perception" other people may have that I am not holding information privately/confidentially.

      As others noted, reminding ourselves to balance and use "self-care" as part of ethical practice is a great reminder why we need to maintain a variety of boundaries. Thank you for your honesty.
      Reply
    • 0 avatar Sandra Nordquist 01.28.2011 07:45
      Yes,I too appreciated the candor, and the details of how a dilemna is looked at and the way the boundary is defined. I must have missed the memo on how we are to take the CEU test at the end of this 5/6 week session course. Can anyone refer me to the email notice that is contained in? Or perhaps a response from Rich Simon himself? Thank you!
      Sandra from Jerome, Idaho
      Reply
    • 0 avatar jody jessup 01.31.2011 17:23
      Right off the bat, the first discussion was extremely valuable to me regarding how to handle a clients questioning regarding our own experiences. I work with eating disorders. This comes up often. I feel like I have found a fit for how to handle that and other similar inquiries by posing the question back to them as to the positives and negatives of "yes I have", or "no I have not". And great advice on ceremony vs. party going. I was doing that intuitively but tentatively so very stabilizing to hear it said out loud. An honest conversation like this from the trenches is very satisfying and highly useful.
      Jody, Door County Wisconsin

      Reply
    • 0 avatar Dawn MacKenzie 02.09.2011 02:19
      The thing that strikes me most about Mary Jo's discussion is her transparency. In my experience, even if clients are bent on talking about their 'stuff' in that first session, engaging them in a transparent discussion about what is to come re: dual relationships (esp important at the very beginning session, I think) always settles their minds, making the remain time productive within a safe context. Thanks to Mary Jo and Rich for this excellent presentation - dawn from Kamloops, BC Canada
      Reply
    • 0 avatar Val Beck Sena 02.09.2011 05:12
      A terrific presentation. I was struck and pleased by Mary Jo's openness in talking about her own practice. I, too, have the "what to expect" talk in the first session. As a 'senior' therapist I guess I'm pretty 'old school'. I emphasize that therapy is a one way relationship, one of the few a person ever experiences. I also explain that I don't touch but I'll hug 'with words' so that they never have to worry about 'what I expect from them'. Obviously this comes up over and over again in the course of therapy. My clients have reported they find great safety and freedom knowing this, even though at times it makes them really sad or mad. I share Mary Jo's value that therapy is sacred.
      Val Beck Sena
      Cincinnati
      Reply
    • 0 avatar Monica Guilhot-Chartrand 05.08.2011 10:10
      I very much appreciated the comment on being watchful about our own personal life moment and how it might affect our way of relating with clients. It appears to me that this is an issue not often brought about in consultation. Another issue I found appropriate and necessary to discuss is "gifts". In working with clients from diverse cultural backgrounds, discussing with them the meaning and intention of the gift, has proven to be more valuable than worrying about having to accept it or not. And last but not least, thanks Mary Jo for presenting in an honest and engaging way. Monica Guilhot, Naperville IL
      Reply
    • 0 avatar Brenda Rozier-Clark 05.31.2011 15:51
      Mary Jo, I appreciate your "exit interview" research that brought forth the conceptual model that highlights this session on 21st Century Ethics! I feel more grounded and safe in myself as I process the issues around Boundaries, Self-Disclosure, and how Dual Relationships can be present in unexpected ways in our communities. And, I like the thinking process of having a Plan with/for Our Client, practicing the Intention of What Is Best for the Client, and naming boundary issues up front in the first sessions. Thanks!
      Reply
    • 0 avatar Irle Goldman 07.24.2011 13:32
      Thank you Mary Jo for your webinar on ethics which I am taking especially now because I am preparing to teach an Ethics course in Israel in the Fall.

      I am heartened and enlightened by how your approach is one of 'Ego' rather than 'Superego'. The latter approach seems to pervade how much of ethics is taught in the field.

      I am taken by how you address these issues through the notion that ethics should merely be an extension of what psychotherapy is and should be, and that psychotherapy is merely and extension of what day to day respectful relationship should be.

      If you have any specific suggestions about teaching this material in Israel, I would love to hear them.

      Irle Goldman
      Reply
    • Not available avatar VeLora Lilly 09.08.2011 13:05
      Great seminar! Very helpful.
      San Francisco, California
      Reply
    • 0 avatar Tina Denison 09.08.2011 13:20
      Wow. This was infinitely more useful than reading the NASW Code of Ethics or discussing these issues in the classroom. As promised, this segment of your ethics course was right to the point, getting to issues and transactions that I already face frequently as a Social Worker in my first year-and-a-half of practice. I am thrilled that I signed up for this series. I found that Rich's interviewing techniques, especially asking for the kind of dialogue Mary Jo might use were invaluable. Thanks, Tina Le Marque, MA, MSW, LMSW, Tucson, Arizona.
      Reply
    • 0 avatar Dale Blumen 09.08.2011 13:31
      I really liked how Mary Jo comes from a stance of "caring for" our clients in a collaborative, respectful and transparent manner. Having conversations with our clients around these common ethical dilemmas even before they arise (e.g., living in a small town) enhances the predictability and safety of the therapy environment. And when we create a plan with our clients during these conversations, we are engaging them in the therapy process as well as strengthening our alliance. Thank you, Mary Jo. Dale Blumen, Newport, RI
      Reply
    • 0 avatar Adam Szmerling 09.08.2011 20:33
      Really like the idea of demystifying the therapy process upfront; talking about therapy. Not assuming that the client has the same theories of change as we do. Working psychodynamically I was trained not to disclose much in this regard in service of more clearly eludicating the transference, but I can appreciate Mary Jo's point. Adam
      Reply
    • 0 avatar jay gorban 09.10.2011 12:53
      Mary Jo, I appreciated all you said but especially how you said it. At the end when you talked about hugs I felt even more connected. I work with so many people who are "hug deprived". I have believed in attachment before it was fashionable. I was trained to work with children and they taught me so much but now work with "grown children". I work a lot with Veterans dealing with severe trauma which often "disconnects them from their essense". I have used emdr for many years and one of the things I appreciate about it is the way it allows for clear boundries. I am not the "healer--they are". We put question marks where they used to have exclamation points. A respectful process. I do believe that Ethics is about respect,honesty and knowing yourself. It's about listening to the story you are being told and reading between the lines. Your knowing who You are is crucial and resonates throughout all you say and do. I have appreciated your work for a long time---guess I'm a groupy.I always feel good hearing you present your views of ethics, therapy and Life. Thank you so much. Jay S. Gorban, Ph.D. Clinical Psychologist, Clarksville, TN.
      Reply
    • 0 avatar David Chervick 09.15.2011 15:44
      Mary Jo did a good job on boundaries , however when she talked about her crush on a client the resolve did not seem genuine.
      As the saying goes, Love cannot be thrown away. If a therapist sees a client as a sexual object therapy stops. As Jung told an admiring client, "A personal relationship is impossible!" At the end, I think she was trying to describe HALT. Check yourself when your hungry, tired, lonely and/or angry. Go find friends and get a life worth exploring. Dave Lake Tahoe, CA
      Reply
    • 0 avatar Candi Kaatz 09.21.2011 23:23
      Candi Nashville
      I appreciated the laid back style of the discussion and the thoughtfulness of replies.
      Reply
    • Not available avatar Marta Lundy 09.24.2011 14:17
      As always, Mary Jo, I appreciated your thoughts. Specifically, I am grateful for the discussion of the type of relationship that you consistently create with your clients. It's critically important to the clinical work but also, invaluable as a tool they can take into their own lives.
      Thank you!
      Marta Lundy
      Reply
    • 0 avatar Dianne Bradley 09.28.2011 15:05
      This was a great session. I believe that Mary Jo gracefully demonstrates the art of therapy with her explanations of how she has worked through each situation. Each example illuminated the fact that the decision was made for the best therapeutic outcomes of the client.
      Reply
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